Exploding health care costs, an aging population, and a shortage of qualified nurses has affected the quality of nursing care in the United States. As a result, it is important to constantly assess the quality of nursing care throughout the country. Traditionally such assessment has been done by individual hospitals or other healthcare facilities. These assessments are typically surveys of the nursing staff. They are conducted through interviews with supervisors or written questionnaires.
These surveys collect information that compares measures of nursing quality with patient outcomes as they relate to nursing care. These measures are known as nursing quality indicators. They are usually monitored over time. They focus on how patients and their conditions are affected by their interaction with nursing staff, how nursing care is delivered, or how staffing patterns affect the quality and quantity of care provided by nurses. Patient outcomes are the end results of the healthcare process. They include adverse outcomes such as pneumonia and pressure ulcers, and positive outcomes such as relief of pain and increase in activities of daily living.
Surveys conducted by individual healthcare facilities result in two problems for facilities and two problems for national health policy. First, while an individual facility may be able to tell if they are improving or deteriorating over time, they will not on their own have the information to determine if they are better or worse than the average facility of their size and type. Second, individual facilities, particularly small facilities, will have insufficient information to identify the relationship between various features of the composition of the nursing work force and patient outcomes and thus will not have an evidence base upon which to design efficient and effective improvements in nursing care.
From a national perspective, if data are collected only by individual facilities, the nation won't have data on trends in nurse staffing and patient outcomes from which to monitor the quality of nursing care, create new policies regarding the nursing shortage, design appropriate guidelines for staffing standards. Further, most individual facilities will not have the resources to develop new indicators of nurse staffing and patient outcomes or to refine existing indicators. New or refined indicators will be needed to expand the assessment of care for all patient populations and to monitor new staffing issues.
The importance of a national, unit-based system for monitoring nursing care and patient outcomes is demonstrated by analysis based on data from such a system that showed that one aspect of nurse staffing, nursing hours per patient day, was related to the patient fall rate on medial and step down units. The association was not present for other measures of nurse staffing, such as skill mix (percentage of hours provided by registered nurses (RNs)) or nurse education and was not present for other unit types, such as critical care or surgical units. This detailed information is more actionable for nurse managers, responsible for the allocation of scare resources among units, than more global hospital-based measures.
A second example from the analysis of an existing system provided information to nurse managers on the quality of the nursing process. Specifically, that among patients who fell, only two-thirds had a prior risk assessment. Of those who had a prior risk assessment, a significant fraction showed the patient not to be at risk for a fall. Finally, of those with a risk assessment and found to be at risk, one-sixth did not receive fall prevention protocol. The outcomes of providing this information to nurse managers could be an extension of the numbers of patients receiving fall risk assessments, improvements in risk assessment tools, and the full implementation of fall prevention protocols among those found to be at risk.
In view of the foregoing, it can be appreciated that a substantial need exists for systems and methods that can advantageously provide for nationwide submission and assessment of both unit-based nursing quality and patient outcome indicators. Further, the system should provide hospitals and policy makers with timely access to comparative, longitudinal benchmarking reports.